Individual provider Active NPI

Nicole Christine Kimble, LISW

  • Clinical Social Worker
  • Mansfield, OH
National Provider Identifier
1699015487
Registry record updated Apr 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I.1500066 Issued in OH
Practice address
741 Scholl Rd
Mansfield, OH 44907-1571
Phone
(419) 774-6827
NPI assigned
Feb 15, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X I.1500066 OH Primary

Addresses

Primary practice location

741 Scholl Rd
Mansfield, OH 44907-1571

Mailing address

741 Scholl Rd
Mansfield, OH 44907-1571
Phone (419) 545-1551

Other names 1

  • Nicole C. Rollins Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181105003129 OH Practitioner - Clinical Social Worker 9638422884 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Center for Individual and Family Services, Inc.Group PAC ID 9133102544, 14 clinicians

Practice addresses (Care Compare)

741 Scholl Rd
Mansfield, OH 44907-1587
Phone (419) 756-1717

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
I.1500066OHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
The Center for Individual & Family Services, Inc. CurrentSince Sep 23, 2018 Accepting new patients
The Center for Individual and Family Services, Inc. CurrentSince Sep 23, 2018 Accepting new patients

Locations

741 Scholl Rd
Mansfield, OH 44907
Phone (419) 756-1717

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1360886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524614400000",
    "number": "1699015487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "741 SCHOLL RD",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449071571",
            "telephone_number": "419-545-1551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "741 SCHOLL RD",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449071571",
            "telephone_number": "419-774-6827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBLE",
        "first_name": "NICOLE",
        "middle_name": "CHRISTINE",
        "name_prefix": "Ms.",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-15",
        "last_updated": "2018-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.1500066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "ROLLINS",
            "middle_name": "C.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mansfield, OH

Sources for this page

Verify at the official NPI Registry.